Ureteroscopy pp 169-187 | Cite as

Management of Urolithiasis in Pregnancy

  • Jennifer Bjazevic
  • John D. DenstedtEmail author


Urinary stone disease in pregnancy is an important clinical scenario which presents unique challenges to the urologist. In order to ensure safe and comprehensive care of both the mother and the fetus, a multidisciplinary approach is highly recommended. A high degree of suspicion is required for the prompt and accurate diagnosis of renal colic during pregnancy. Given the potential serious risks of radiation exposure during pregnancy, careful consideration must be given to the use of diagnostic imaging in this context. Management must be individualized to the patient and clinical situation but generally proceeds from conservative to more invasive approaches. Expectant management is recommended as first-line treatment when there are no contraindications. However, recent advances in endourological equipment and techniques and obstetrical care have allowed for an increased role of primary surgical management with ureteroscopy. It is essential for the practicing urologist to understand the intricacies of diagnosing and managing stone disease in pregnancy in order to reduce the potential for patient morbidity and complications.


Urolithiasis Calculi Pregnancy Diagnosis Urinary tract imaging Management Ureteric stent Nephrostomy tube Medical expulsive therapy Ureteroscopy Laser lithotripsy 


  1. 1.
    Ramello A, Vitale C, Marangella M. Epidemiology of nephrolithiasis. J Nephrol. 2000;13(Suppl 3):S45–50.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Scales CD, Smith AC, Hanley JM, Saigal CS. Prevalence of kidney stones in the United States. Eur Urol. 2012;62:160–5.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Stamatelou KK, Francis ME, Jones CA, Nyberg LM, Curhan GC. Time trends in reported prevalence of kidney stones in the United States: 1976–1994. Kidney Int. 2003;63:1817–23.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Yasui T, Iguchi M, Suzuki S, Kohri K. Prevalence and epidemiological characteristics of urolithiasis in Japan: national trends between 1965 and 2005. Urology. 2008;7:209–13.CrossRefGoogle Scholar
  5. 5.
    Indridason OS, Birgisson S, Edvardsson VO, Sigvaldason H, Sigfusson N, Palsson R. Epidemiology of kidney stones in Iceland: a population-based study. Scand J Urol Nephrol. 2006;40:215–20.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Lieske JC, Pena de la Vega LS, Slezak JM, Bergstralh EJ, Leibson CL, Ho KL, et al. Renal stone epidemiology in Rochester, Minnesota: an update. Kidney Int. 2006;69:760–4.CrossRefGoogle Scholar
  7. 7.
    Strope SA, Wolf JS, Hollenbeck BK. Changes in gender distribution of urinary stone disease. Urology. 2010;75:543–6.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Gorton E, Whiteld HN. Renal calculi in pregnancy. Br J Urol. 2007;80:4–9.Google Scholar
  9. 9.
    Srirangam SJ, Hickerton B, Van Cleyenbreugel B. Management of urinary calculi in pregnancy: a review. J Endourol. 2008;22:867–75.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Riley JM, Dudley AG, Semins MJ. Nephrolithiasis and pregnancy: has the incidence been rising? J Endourol. 2014;28:383–6.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Ross AE, Handa S, Lingeman JE, Matlaga BR. Kidney stones during pregnancy: an investigation into stone composition. Urol Res. 2008;36:99–102.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Reinstatler L, Khaleel S, Pais VM. Association of pregnancy with stone formation among women in the United States: a NHANES Analysis 2007 to 2012. J Urol. 2017;198:389–93.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Grenier N, Pariente JL, Trillaud H, Soussotte C, Douws C. Dilatation of the collecting system during pregnancy: physiologic vs obstructive dilatation. Eur Radiol. 2000;10:271–9.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Marchant DJ. Effects of pregnancy and progestational agents on the urinary tract. Am J Obstet Gynecol. 1972;112:487–501.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Dunlop W. Serial changes in renal hemodynamics during normal human pregnancy. Br J Obstet Gynaecol. 1981;88:1–9.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Charalambous S, Fotas A, Rizk DE. Urolithiasis in pregnancy. Int Urogynecol J. 2009;20:1133–6.CrossRefGoogle Scholar
  17. 17.
    Loughlin KR. Management of urologic problems during pregnancy. Urology. 1994;44:159–69.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Parulkar BG, Hopkins TB, Wollin MR, Howard PJ, Lal A. Renal colic during pregnancy: a case for conservative treatment. J Urol. 1998;159:365–8.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Smith C, Kristensen C, Davis M, Abraham PA. An evaluation of the physicochemical risk for renal stone disease during pregnancy. Clin Nephrol. 2001;55:205–11.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Resim S, Ekerbicer HC, Kiran G, Kilinc M. Are changes in urinary parameters during pregnancy clinically significant? Urol Res. 2006;34:244–8.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Buppasiri P, Lumbiganon P, Thinkhamrop J, Ngamjarus C, Laopaiboon M, Medley N. Calcium supplementation (other than for preventing or treating hypertension) for improving pregnancy and infant outcomes. Cochrane Database Syst Rev. 2015;
  22. 22.
    Imdad A, Bhutta ZA. Effect of calcium supplementation during pregnancy on maternal, fetal and birth outcomes. Paediatr Perinat Epidemiol. 2012;1:138–52.CrossRefGoogle Scholar
  23. 23.
    Loughlin KR, Bailey RB. Internal ureteral stents for conservative management of ureteral calculi during pregnancy. N Engl J Med. 1986;315:1647–9.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Maikranz P, Lindheimer M, Coe F. Nephrolithiasis in pregnancy. Baillie Res Clin Obstet Gynaecol. 1994;8:375–86.CrossRefGoogle Scholar
  25. 25.
    Meria P, Hadjadj H, Jungers P, Daudon M, Members of the French Urological Association Urolithiasis Committee. Stone formation and pregnancy: pathophysiological insights gained from morphoconstitutional stone analysis. J Urol. 2010;183:1412–6.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Stothers L, Lee LM. Renal colic in pregnancy. J Urol. 1992;148:1383–7.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Burgess KL, Gettman MT, Rangel LJ, Krambeck AE. Diagnosis of urolithiasis and rate of spontaneous passage during pregnancy. J Urol. 2011;186:2280–4.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Biyani CS, Joyce AD. Urolithiasis in pregnancy. I: pathophysiology, fetal considerations and diagnosis. BJU Int. 2002;89:811–8.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Lewis DF, Robichaux AG, Jaekle RK, Marcum NG, Stedman CM. Urolithiasis in pregnancy. Diagnosis, management and pregnancy outcome. J Reprod Med. 2003;48:28–32.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Banhidy F, Acs N, Puho EH, Czeizel AE. Maternal kidney stones during pregnancy and adverse birth outcomes, particularly congenital abnormalities in the offspring. Arch Gynecol Obstet. 2007;275:481–7.CrossRefGoogle Scholar
  31. 31.
    Wright A, Walker R, Barrett D. The fluoroquinolones and their appropriate use in treatment of genitourinary tract infections. In: Ball T, Novicki D, editors. AUA update series. Houston: American Urologic Association; 1993.Google Scholar
  32. 32.
    Brent RL, Mettler FA. Pregnancy policy. Am J Roentgenol. 2004;182:819–22.CrossRefGoogle Scholar
  33. 33.
    White WM, Zite NB, Gash J, Waters WB, Thompson W, Klain FA. Low-dose computed tomography for the evaluation of flank pain in the pregnant population. J Endourol. 2007;21:1255–60.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    American College of Obstetricians and Gynecologists. Guidelines for diagnostic imaging during pregnancy and lactation. Committee Opinion No. 723. Obstet Gynecol. 2017;130:e210–6.CrossRefGoogle Scholar
  35. 35.
    Kalyani V, Krambeck AE, Atwell T. Pearls and pitfalls in sonographic imaging of urolithiasis in pregnancy. Ultrasound Q. 2013;29:51–9.CrossRefGoogle Scholar
  36. 36.
    Wachsberg RH. Unilateral absence of ureteral jets in the third trimester of pregnancy: pitfall in color Doppler US diagnosis of urinary obstruction. Radiology. 1998;209:279281.CrossRefGoogle Scholar
  37. 37.
    Vallurupalli K, Atwell TD, Krambeck AE, Traynor KD, Broun D, Leroy AJ. Pearls and pitfalls in sonographic imaging of symptomatic urolithiasis in pregnancy. Ultrasound Q. 2013;29:51–9.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Sheafor DH, Hertzberg BS, Freed KS, Carroll BA, Keogan MT, Paulson EK, et al. Nonenhanced helical CT and US in the emergency evaluation of patients with renal colic: prospective comparison. Radiology. 2000;217:792–7.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Burge HJ, Middleton WD, McClennan BL, Hildebolt CF. Ureteral jets in healthy subjects and in patients with unilateral ureteral calculi: comparison with color doppler US. Radiology. 1991;180:437–42.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Andreoiu M, MacMahon R. Renal colic in pregnancy: lithiasis or physiological hydronephrosis? Urology. 2009;74:757–61.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Keogan MT, Kliewer MA, Hertzberg BS, DeLong DM, Tupler RH, Carroll BA. Renal resistive indexes: variability in Doppler US measurement in a healthy population. Radiology. 1996;199:165–9.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Hamm M, Knopfle E, Wartenberg S, Wawroschek F, Weckermann D, Harzmann R. Low dose unenhanced helical computerized tomography for the evaluation of acute flank pain. J Urol. 2002;167:1687–91.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Lazarus E, Debenedectis C, North D, Spencer PK, Mayo-Smith WW. Utilization of imaging in pregnant patients: 10-year review of 5270 examinations in 3285 patients – 1997–2006. Radiology. 2009;251:517–24.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    White WM, Johnson EB, Zite NB, Beddies J, Krambeck AE, Hyams E, et al. Predictive value of current imaging modalities for the detection of urolithiasis during pregnancy: a multi-center, longitudinal study. J Urol. 2013;189:931–4.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Fulgham PF, Assimos DG, Pearle MS, Preminger GM. Clinical effectiveness protocols for imaging in the management of ureteral calculous disease: AUA technology assessment. J Urol. 2013;189:1203–13.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Semins MJ, Matlaga BR. Management of urolithiasis in pregnancy. Int J Women’s Health. 2013;5:599–604.Google Scholar
  47. 47.
    Spencer JA, Chahal R, Kelly A, Taylor K, Eardley I, Lloyd SN. Evaluation of painful hydronephrosis in pregnancy: magnetic resonance urographic patterns in physiological dilatation versus calculous obstruction. J Urol. 2004;171:256–60.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ, Park AL. Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA. 2016;316:952–61.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Cheek TG, Baird E. Anesthesia for nonobstetric surgery: maternal and fetal considerations. Clin Obstet Gynecol. 2009;99:535–45.CrossRefGoogle Scholar
  50. 50.
    Burdan F, Starosławska E, Szumiło J. Prenatal tolerability of acetaminophen and other over-the-counter non-selective 93 cyclooxygenase inhibitors. Pharmacol Rep. 2012;64:521–7.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Broussard CS, Rasmussen SA, Reefhuis J, Friedman JM, Jann MW, Riehle-Colarusso T, et al. Maternal treatment with opioid analgesics and risk for birth defects. Am J Obstet. 2011;204:e1–11.CrossRefGoogle Scholar
  52. 52.
    Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, et al. Surgical management of stones: American Urological Association/Endourological Society Guideline, part II. J Urol. 2016;196:1161–9.PubMedCrossRefPubMedCentralGoogle Scholar
  53. 53.
    Weber-Schoendorfer C, Hannemann D, Meister R, Elefant E, Cuppers-Maarschalkerweerd B, Arnon J, et al. The safety of calcium channel blockers during pregnancy: a prospective, multicenter, observational study. Reprod Toxicol. 2008;26:24–30.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    Bailey G, Vaughan L, Rose C, Krambeck A. Perinatal out- comes with tamsulosin therapy for symptomatic urolithiasis. J Urol. 2016;195:99.PubMedCrossRefPubMedCentralGoogle Scholar
  55. 55.
    Lloyd GL, Lim A, Hamoui N, Nakada SY, Kielb SJ. The use of medical expulsive therapy during pregnancy: a worldwide perspective among experts. J Endourol. 2016;30:354–8.PubMedCrossRefPubMedCentralGoogle Scholar
  56. 56.
    Jarrard DJ, Gerber GS, Lyon ES. Management of acute ureteral obstruction in pregnancy utilizing ultrasound- guided placement of ureteral stents. Urology. 1993;42:263–8.PubMedCrossRefPubMedCentralGoogle Scholar
  57. 57.
    Pearle MS, Pierce HL, Miller GL, Summa JA, Mutz JM, Petty BA, et al. Optimal method of urgent decompression of the collecting system for obstruction and infection due to ureteral calculi. J Urol. 1998;160:1260–4.PubMedCrossRefPubMedCentralGoogle Scholar
  58. 58.
    Fregonesi A, Dias FGF, Saade RD, Dechaalani V, Reis LO. Challenges on percutaneous nephrolithotomy in pregnancy: supine position approach through ultrasound guidance. Urol Ann. 2013;5:107–9.Google Scholar
  59. 59.
    Toth C, Toth G, Varga A, Flasko T, Salah MA. Percutaneous nephrolithotomy in early pregnancy. Int Urol Nephrol. 2005;37:1–3.PubMedCrossRefPubMedCentralGoogle Scholar
  60. 60.
    Chaussy CG, Fuchs GJ. Current state and future developments of noninvasive treatment of human urinary stones with extracorporeal shock wave lithotripsy. J Urol. 1989;141:782–9.PubMedCrossRefPubMedCentralGoogle Scholar
  61. 61.
    Asgari MA, Safarinejad MR, Hosseini SY, Dadkhah F. Extracorporeal shock wave lithotripsy of renal calculi during early pregnancy. BJU Int. 1999;84:615–7.PubMedCrossRefPubMedCentralGoogle Scholar
  62. 62.
    Semins MJ, Trock BJ, Matlaga BR. The safety of ureteroscopy during pregnancy: a systematic review and meta-analysis. J Urol. 2009;181:139–43.CrossRefGoogle Scholar
  63. 63.
    Denstedt JD, Razvi H. Management of urinary calculi during pregnancy. J Urol. 1992;148(3 Pt 2):1072–4.PubMedCrossRefPubMedCentralGoogle Scholar
  64. 64.
    Ulvik NM, Bakke A, Høisaeter PA. Ureteroscopy in pregnancy. J Urol. 1995;154:1660–3.PubMedCrossRefPubMedCentralGoogle Scholar
  65. 65.
    Carringer M, Swartz R, Johansson JE. Management of ureteric calculi during pregnancy by ureteroscopy and laser lithotripsy. BJU. 1996;77:17–20.PubMedCrossRefPubMedCentralGoogle Scholar
  66. 66.
    Scarpa RM, De Lisa A, Usai E. Diagnosis and treatment of ureteral calculi during pregnancy with rigid ureteroscopes. J Urol. 1996;155:875–7.PubMedCrossRefPubMedCentralGoogle Scholar
  67. 67.
    Lemos GC, El Hayek OR, Apezzato M. Rigid ureteroscopy for diagnosis and treatment of ureteral calculi during pregnancy. Int Braz J Urol. 2002;28:311–5.PubMedPubMedCentralGoogle Scholar
  68. 68.
    Lifshitz DA, Lingeman JE. Ureteroscopy as a first-line intervention for ureteral calculi in pregnancy. J Endourol. 2002;16:19–22.PubMedCrossRefPubMedCentralGoogle Scholar
  69. 69.
    Shokeir AA, Mutabani H. Rigid ureteroscopy in pregnant women. BJU. 1998;81:678–81; Lemos GC, El Hayek OR, Apezzato M. Rigid ureteroscopy for diagnosis and treatment of ureteral calculi during pregnancy. Int Braz J Urol. 2002;28:311–5.CrossRefGoogle Scholar
  70. 70.
    Watterson JD, Girvan AR, Beiko DT. Ureteroscopy and holmium:YAG laser lithotripsy: an emerging definitive management strategy for symptomatic ureteral calculi in pregnancy. Urology. 2002;60:383–7.PubMedCrossRefPubMedCentralGoogle Scholar
  71. 71.
    Akpinar H, Tufek I, Alici B. Ureteroscopy and holmium laser lithotripsy in pregnancy: stents must be used post- operatively. J Endourol. 2006;20:107–10.PubMedCrossRefPubMedCentralGoogle Scholar
  72. 72.
    Juan YS, Wu WJ, Chuang SM, et al. Management of symptomatic urolithiasis during pregnancy. Kaohsiung J Med Sci. 2007;23:241–6.PubMedCrossRefPubMedCentralGoogle Scholar
  73. 73.
    Yang CH, Chan PH, La SK, et al. Urolithiasis in pregnancy. J Chin Med Assoc. 2007;67:625–8.Google Scholar
  74. 74.
    Rana AM, Aquil S, Khawaja AM. Semirigid ureteroscopy and pneumatic lithotripsy as definitive management of obstructive ureteral calculi during pregnancy. Urology. 2009;73:964–7.PubMedPubMedCentralCrossRefGoogle Scholar
  75. 75.
    Travassos M, Amselem I, Filho NS. Ureteroscopy in pregnant women for ureteral stone. J Endourol. 2009;23:405–7.PubMedPubMedCentralCrossRefGoogle Scholar
  76. 76.
    Cocuzza M, Colombo JJr JR, Lopes RI, et al. Use of inverted fluoroscope’s C-arm during endoscopic treatment of urinary tract obstruction in pregnancy: a practicable solution to cut radiation. Urology. 2010;75:1505–8.PubMedCrossRefPubMedCentralGoogle Scholar
  77. 77.
    Elgamasy A, Elsherif A. Use of Doppler ultrasonography and rigid ureteroscopy for managing symptomatic ureteric stones during pregnancy. BJU Int. 2010;106:262–6.PubMedCrossRefPubMedCentralGoogle Scholar
  78. 78.
    Polat F, Yesil S, Kirac M, et al. Treatment outcomes of semirigid ureterorenoscopy and intracorporeal lithotripsy in pregnant women with obstructive ureteral calculi. Urol Res. 2011;39:487–90.PubMedPubMedCentralCrossRefGoogle Scholar
  79. 79.
    Atar M, Bozkurt Y, Soylemez H. Use of renal resistive index and semi-rigid ureteroscopy for managing symptomatic persistent hydronephrosis during pregnancy. Int J Surg. 2012;10:629–33.PubMedCrossRefPubMedCentralGoogle Scholar
  80. 80.
    Hoscan MB, Ekinci M, Tunckiran A, et al. Management of symptomatic ureteral calculi complicating pregnancy. Urology. 2012;80:1011–4.PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    Isen K, Hatipoglu NK, Dedeoglu S, et al. Experience with the diagnosis and management of symptomatic ureteric stones during pregnancy. Urology. 2012;79:508–12.PubMedCrossRefPubMedCentralGoogle Scholar
  82. 82.
    Johnson EB, Krambeck AE, White WM. Obstetric complications of ureteroscopy during pregnancy. J Urol. 2012;188:151–4.PubMedPubMedCentralCrossRefGoogle Scholar
  83. 83.
    Bozkurt Y, Soylemez H, Atar M. Effectiveness and safety of ureteroscopy in pregnant women: a comparative study. Urolithiasis. 2013;41:37–42.CrossRefGoogle Scholar
  84. 84.
    Abdel-Kader MS, Tamam AA, Elderwy AA, et al. Management of symptomatic ureteral calculi during pregnancy: experience of 23 cases. Urol Ann. 2013;5:241–4.PubMedPubMedCentralCrossRefGoogle Scholar
  85. 85.
    Keshvari Shirvan M, Darabi Mahboub MR, Rahimi HR, et al. The evaluation of ureteroscopy and pneumatic lithotripsy results in pregnant women with ureteral calculi. Nephrourol Mon. 2013;5:874–8.PubMedPubMedCentralCrossRefGoogle Scholar
  86. 86.
    Wang Z, Xu L, Su Z, Yao C, et al. Invasive management of proximal ureteral calculi during pregnancy. Urology. 2014;83:745–9.PubMedCrossRefPubMedCentralGoogle Scholar
  87. 87.
    Adanur S, Ziypak T, Bedir F, Yapanoglu T, et al. Ureteroscopy and holmium laser lithotripsy: is this procedure safe in pregnant women with ureteral stones at different locations? Arch Ital Urol Androl. 2014;30:86–9.CrossRefGoogle Scholar
  88. 88.
    Teleb M, Ragab A, Dawod T, Elgalay H. Definitive ureteroscopy and intracorporeal lithotripsy in treatment of ureteral calculi during pregnancy. Arab J Urol. 2014;12:299–303.PubMedPubMedCentralCrossRefGoogle Scholar
  89. 89.
    Shang S, Liu G, Duo Y, Wang J, et al. Application of ureteroscope in emergency treatment with persistent renal colic patients during pregnancy. PLoS One. 2016;11:e0146597.CrossRefGoogle Scholar
  90. 90.
    Tan S, Chen X, Sun M, Wu B. The comparation of effects and security of double-J stent retention and ureteroscopy lithotripsy in the treatment of symptomatic ureteral calculi during pregnancy. Eur J Obstet Gynecol Reprodu Biol. 2018;227:32–4.CrossRefGoogle Scholar
  91. 91.
    Song Y, Fei X, Song Y. Diagnosis and operative intervention for problematic ureteral calculi during pregnancy. Int J Gynaecol Obstet. 2013;12:115–8.CrossRefGoogle Scholar
  92. 92.
    Bayar G, Bozkurt Y, Acinikli H, Dagguli M. Which treatment method should be used in pregnant patients with ureteral calculi? Two center comparative study. Arch Esp Urol. 2015;68:435–40.PubMedPubMedCentralGoogle Scholar
  93. 93.
    Wymer K, Plunkett BA, Park S. Urolithiasis in pregnancy: a cost-effectiveness analysis of ureteroscopic management vs ureteral stenting. Am J Obstet Gynecol. 2015;213:691e1–8.CrossRefGoogle Scholar
  94. 94.
    Practice ACoO. ACOG Committee Opinion No. 464: nonobstetric surgery during pregnancy. Obstet Gynecol. 2011;117:420–1.CrossRefGoogle Scholar
  95. 95.
    Rivera ME, McAlvany KL, Brinton TS, Gettman MT. Anesthetic exposure in the treatment of symptomatic urinary calculi in pregnant women. Urology. 2014;84:1275–8.PubMedCrossRefPubMedCentralGoogle Scholar
  96. 96.
    Razvi H, Bensalah K, Peyronnet B, Gross A, Krambeck A, Smith A, et al. Stones in special situations. In: Denstedt J, Rosette J, editors. Stone disease. Montreal: Societe Internationale d’Urologie (SIU); 2014. p. 409–501.Google Scholar
  97. 97.
    Deters LA, Dagrosa LM, Herrick BW, Silas A, Pais VM. Ultrasound guided ureteroscopy for definitive management of ureteral stones: a randomized, controlled trial. J Urol. 2014;192:1710–3.PubMedCrossRefPubMedCentralGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Surgery, Division of UrologySchulich School of Medicine & Dentistry, Western UniversityLondonCanada

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